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ABCDE bundle, Intensive care unit, Quality improvement



  1. Pinto, Floriana RN
  2. Biancofiore, Gianni MD


Background: The ABCDE (Awakening and Breathing coordination of daily sedation and ventilator removal trials; Choice of sedative or analgesic exposure; Delirium monitoring and management; and Early mobility and exercise) bundle is a multidisciplinary set of evidence-based practices for improving patient outcomes in the intensive care unit. Nurses are critical to all the bundle's requirements. Therefore, understanding their knowledge, attitudes, and perception of the different bundle's components might help for an easier implementation into everyday clinical practice.


Objective: The aim of this study was to assess nurses' knowledge, utility, and perception of the ABCDE bundle.


Methods: An anonymous questionnaire with closed-end questions was administered to the nurses working at the intensive care unit (ICU) of a nationwide teaching hospital.


Results: Only the 41.6% of the respondents declared to be aware of the bundle; however, the majority of them (67%) agreed with its potential capability of improving patients' outcomes after reviewing a document as they completed a survey. In addition, 71% of responders judged the Sedation Awakening Trial and the Spontaneous Breathing Trial easy to understand, and 80% found the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the ICU useful to asses and monitor delirium. However, 48% reported that they did not currently use them. Fifty-one percent of respondents reported that they were not aware of or had used the Exercise/Mobility Safety Screen. Fifty-three respondents reported that multidisciplinary rounds were not performed at their ICU but judged them as a positive activity. Only 34% of the respondents considered the ABCDE bundle applicable at their own ICU.


Discussion: A substantial need for educational improvement and cultural change is needed. The results of this study may help other facilities to identify contextual and professionals-related factors possibly hindering the bundle's implementation.